BY CAROL VAUGHN, Eastern Shore Post
What if there were a medicine that might alleviate patients’ pain or ameliorate their ailments, but a doctor was not allowed to tell them about it?
That is the situation in which some patients and doctors on the Eastern Shore find themselves when it comes to medical marijuana.
Medical marijuana is legal in Virginia, but some patients on the Shore are having difficulty learning about it, including whether it might benefit them, and how to access it.
Eastern Shore Rural Health System and Riverside Health System service the majority of the area’s health needs.
Rural Health won’t allow its physicians to discuss medical marijuana. A Riverside Health System public relations spokesperson declined to discuss medical marijuana with the Eastern Shore Post.
Additionally, the nearest state-licensed dispensary for Eastern Shore residents is in Virginia Beach — many miles and a Chesapeake Bay Bridge-Tunnel toll away. Virginia residents cannot use Maryland dispensaries.
Telehealth option
Jacqueline Craft is a retiree who has tried multiple ways to relieve the pain she suffers from spinal stenosis — including cortisone shots, radio frequency ablation, and prescription pain relievers.
She can’t take NSAIDs — non-steroidal anti-inflammatory drugs — because she takes a blood thinner.
“When the pain hits from my back, it’s … to say the least, it brings me to my knees. So I was desperate. All I could take was Tylenol,” she said.
She sought a medical marijuana certificate as a last resort, although she was leery of the drug.
She was able to consult with a medical professional she knew via Zoom. He wrote down the information about her condition and what she had tried, and then issued her a certificate in August.
A certificate, issued by a board-registered practitioner, is needed to access Virginia marijuana dispensaries.
A state database lists five medical professionals on the Shore among the hundreds of doctors who have registered to provide medical marijuana certificates to Virginia patients.
Prohibited from discussing
Rural Health prohibits its providers from discussing medical marijuana with patients, providing the certificate required to access Virginia dispensaries, or even referring patients to another doctor who could provide them a certificate.
The reason, according to Rural Health administrators, is that marijuana is illegal at the federal level.
Kimberly Savage, the Rural Health chief compliance officer, said the federal Controlled Substances Act prohibits possession, manufacturing, and distribution of marijuana, even for medical purposes, regardless of state law.
“In this case federal law supersedes state law,” said Savage in an emailed reponse to a patient’s query.
She also wrote that Rural Health’s status as a Federally Qualified Health Center — a federal Section 220 grantee — means it is bound by federal marijuana prohibitions.
Additionally, a Rural Health employee could be in violation of the organization’s conflict of interest policy if he or she provides certificates outside of their Rural Health employment, according to Savage.
“(P)ractitioners who see patients in our centers who provide medical cannabis certification could be in violation with our conflict of interest policy, particularly if they refer Eastern Shore Rural Health patients to their practices outside the health center to provide medical certification.
“The Physician Self-Referral Law, also known as the ‘Stark Law,’ prohibits a physician from making referrals to an entity (or themselves), if the physician has a financial relationship with the entity,” she wrote.
Employees are required to notify the organization’s human resources of all “moonlighting” activity in advance.
“Certified or not, federal law prohibits our providers from guiding patients to or connecting patients with sources of medical marijuana — that is a hard stop,” according to written responses Rural Health made to questions posed by the Post.
Matt Clay, the Rural Health chief executive, contacted other community health centers in the state, as well as the National Association of Community Health Centers, about the issue of providing medical marijuana certificates.
The other CEOs he spoke with also do not allow their providers to guide patients to resources to obtain medical marijuana.
“If and when cannabis becomes legal at the federal level we will re-evaluate this issue,” Rural Health officials wrote in a response to the Post.
“We will cross this bridge when we come to it.”
Riverside Health System wouldn’t even discuss medical marijuana with a reporter who asked for answers to questions about the topic.
“At this time, Riverside is unavailable to discuss,” was the reply given by the organization’s public relations firm.
‘Legitimate answer to pain’
Although recreational marijuana retail sales are not legal in Virginia yet, around 20,300 patients currently are receiving medical marijuana products legally in the state, according to Ngsite Abebe, vice president of public policy at Columbia Care, the company with two state licenses to process marijuana for medical use.
Abebe was quoted in a Sept. 30 article in Axios Richmond.
Pain, anxiety, and insomnia are the most common reasons patients seek medical marijuana products. Anecdotally, the average Virginia patient seems to be a 55-year-old woman, according to Abebe.
Dr. Shirley Mason Randall, who owns the Eastern Shore Pain Management Center in Exmore, said many of her patients are “very interested” in medical marijuana.
She estimates she has provided certificates to around 60 to 100 patients in the past two years, after medical marijuana became legal in Virginia.
“Most patients say that using cannabis relieves anxiety and aids with sleeping. So far, the benefits for pain relief is minimal, but I will continue to monitor this,” she said.
She added, “If a patient gets a significant amount of relief from cannabis use, this would be good, since there would be less to no need for narcotic therapy.”
For Craft, medical marijuana is helping, and the professionalism of the certification and dispensary procedures helped alleviate her concerns about what she once thought of as a gateway drug.
“I wasn’t going to do anything illegal,” she said.
“It’s very professional looking. … They have pharmacists on duty,” she said of the dispensary.
After discussing her condition with the pharmacist, he recommended half a 10-milligram pill for her pain.
“It does not make me high. … I take it on days when I’m not going anywhere because I don’t want to drive, but I don’t feel any ‘high,’” she said.
“My experience has been, what I’m taking right now does not make me dysfunctional but it does help with my pain,” Craft said.
Her son noticed the difference in his mother’s demeanor when he visited for her birthday in October.
“You were an entirely different person,” he told her later.
Craft says medical marijuana should be looked at as just another medicine that may be useful.
“It’s a legitimate answer to pain.”
